Rigberg David A, Jimenez Juan Carlos, Lawrence Peter F
Department of Vascular Surgery, University of California-Los Angeles, Los Angeles, CA 90095-6908, USA.
Ann Vasc Surg. 2008 Mar;22(2):200-2. doi: 10.1016/j.avsg.2007.12.003.
Renal cell carcinoma has a tendency to extend via the renal vein into the inferior vena cava (IVC), and we describe a novel approach to this situation. A 64-year-old male presented with metastatic right renal cell carcinoma and tumor thrombus extending into the retrohepatic IVC. Preoperative imaging revealed a large hemangioma adjacent to the IVC, potentially complicating hepatic mobilization. Instead, we used a compliant balloon to occlude the suprahepatic IVC, securing the wire in the right hepatic vein. With the infrarenal IVC and left renal vein occluded, the thrombus was extracted via a right renal venotomy/partial cavotomy with minimal bleeding. Balloon occlusion of the suprahepatic IVC offers a safe alternative to surgical control of this vessel in difficult situations. In addition, it allows for nephrectomy through a conventional, small retroperitoneal incision rather than the extended exposure needed for the IVC. Hepatic vein positioning of the wire prevents thrombus manipulation during balloon placement.
肾细胞癌有经肾静脉延伸至下腔静脉（IVC）的倾向，我们描述了一种针对这种情况的新方法。一名64岁男性，患有转移性右肾细胞癌且肿瘤血栓延伸至肝后下腔静脉。术前影像学检查发现下腔静脉旁有一个大的血管瘤，可能会使肝脏游离变得复杂。相反，我们使用顺应性球囊阻断肝上腔静脉，将导丝固定在右肝静脉内。在肾下腔静脉和左肾静脉被阻断的情况下，通过右肾静脉切开术/部分腔静脉切开术取出血栓，出血极少。肝上腔静脉球囊阻断术为难治情况下该血管的手术控制提供了一种安全的替代方法。此外，它允许通过传统的小腹膜后切口进行肾切除术，而不是下腔静脉所需的扩大暴露。导丝在肝静脉的定位可防止球囊放置过程中血栓被操作。
